304314137-9-8-2023-06-CC-KNAR-CVGPZN-20230908114549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314137
Report Date: 09/08/2023
Date Signed: 09/08/2023 11:45:57 AM

Document Has Been Signed on 09/08/2023 11:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	VALLEJO, JEIMY		FACILITY NUMBER:	304314137
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 7	CENSUS: 4	DATE:	09/08/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Vallejo, Jeimy		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Page 1 Licensing Program Analyst (LPA’s) Karen Navar conducted an unannounced case management inspection for the purpose of increasing capacity. The licensee Jeimy Vallejo is currently licensed for a small family childcare home for a capacity of 8 children. The licensee has requested to operate as large family childcare home for a capacity of 14 children. LPA met with licensee, Jeimy Vallejo and toured the facility. 1 assistant was present and was monitoring children. There was a total of 3 children and 1 infant at the time of inspection A review of criminal clearance records on this date indicates adults who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are (3) adult resident and the licensee living in the home as well as 3 children. Licensee is Pediatric First Aid and CPR certified with an expiration date of January 2025. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. She was reminded if changes to notify the licensing office. Licensee stated there are no pets. The facility is a two-story home with four bedrooms and three bathrooms. The licensee has designated the dining room, office, backyard, and bathroom located in the living room for day care children's use. The off-limits areas are the kitchen made in accessible to children by the means of a safety gate, the living room has a fireplace and is inaccessible to children by a child safety gate, the second floor has 4 bedrooms and two bathrooms with a laundry room that are made in accessible to children by a child safety gate at the bottom of the stairs. The licensee has a cell phone to use for childcare. LPA informed the licensee that the cell phone for childcare must always remain on the premises during hours of operation 7:30 am-5:00pm. Licensee stated that she provides breakfast for children dropped off before 9:00am and then provides lunch and snack. Licensee stated if children have allergies that parents will bring the food for the Cont. Page 2

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VALLEJO, JEIMY	FACILITY NUMBER: 304314137
	VISIT DATE: 09/08/2023

NARRATIVE

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child. Licensee stated that there is not smoking at the home. Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen are all inaccessible to children. Poisons/Hazardous items are not stored on site, and none were observed. There is a door next to the backyard that leads to the garage and is locked during business hours. Licensee said per fire department no child safe door knob should be placed on it. LPA informed Licensee to have 100% supervision as children walk through living room to backyard or bathroom. There are no bodies of water observed at the facility. Licensee stated that there are no weapons at the facility.

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by law to post the following:

Facility License (LIC 203), Waivers (if applicable), Notification of Parent’s Rights Poster (PUB 394), Earthquake Preparedness Checklist (LIC 9148), Emergency Disaster Plan (LIC 610A) California Car Seat Law (PUB 269). ). A Notice of Site Visit (LIC 9213) must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

LPA reviewed Unusual Incident Report (UIR) form (LIC 624B)-advised to contact Licensing Officer of the Day within 24 hours and complete the UIR within seven days by faxing LIC624B to (714)703-2831. LPA advised applicant to report to licensing any unusual incident or child absence that threatens the physical or emotional health or safety of any child or any changes to hours and days of operation and for any changes to facility, including on/off limit areas and change in phone number.

LPA reviewed with licensee requirements of Disaster Preparedness drills (documented every 6 months). The LPA advised of Affidavit Regarding Liability Insurance (LIC 282) if did not purchase liability insurance and to maintain the form in the children's files, and Car Safety Seat pamphlet were discussed and provided to the applicant.

The licensee has completed the Mandated Reporter Training for self and it expires 10/2024. Department web site form was given to download forms, Title 22 regulations, and trainings on-line at http://www.ccld.ca.gov. The licensee has registered to obtain quarterly updates and notifications from the Department.

Cont. Page 3

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: VALLEJO, JEIMY	FACILITY NUMBER: 304314137
	VISIT DATE: 09/08/2023

NARRATIVE

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Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. was provided.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

LPA discussed the safe sleep regulations with the applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed the applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The LPA informed Licensee of Lead Exposure and was informed of about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chapter Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdfAppeal Rights and the appeal rights process was discussed with the applicant. The applicant was informed all appeals must be in writing and received by the licensing office within 15 business days.

An exit interview conducted where the report was reviewed with the applicant. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

The Small Family Child Care Home was in compliance with Title 22 Regulations at the time of inspection. In the event additional requirements are needed, the applicant will be notified.

Appeal rights were provided, and an Exit Interview was conducted with applicant Vallejo, Jeimy.

The operation hours is from 7:30 am to 5:00pm Monday through Friday for ages 3 months – 12 years.

This report ends here.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

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